Yuen K Y, Chan P K, Peiris M, Tsang D N, Que T L, Shortridge K F, Cheung P T, To W K, Ho E T, Sung R, Cheng A F
Department of Microbiology, University of Hong Kong, China.
Lancet. 1998 Feb 14;351(9101):467-71. doi: 10.1016/s0140-6736(98)01182-9.
Human infection with an avian influenza A virus (subtype H5N1) was reported recently in Hong Kong. We describe the clinical presentation of the first 12 patients and options for rapid viral diagnosis.
Case notes of 12 patients with virus-culture-confirmed influenza A H5N1 infection were analysed. The clinical presentation and risk factors associated with severe disease were defined and the results of methods for rapid virus diagnosis were compared.
Patients ranged from 1 to 60 years of age. Clinical presentation was that of an influenza-like illness with evidence of pneumonia in seven patients. All seven patients older than 13 years had severe disease (four deaths), whereas children 5 years or younger had mild symptoms with the exception of one who died with Reye's syndrome associated with intake of aspirin. Gastrointestinal manifestations, raised liver enzymes, renal failure unrelated to rhabdomyolysis, and pancytopenia were unusually prominent. Factors associated with severe disease included older age, delay in hospitalisation, lower-respiratory-tract involvement, and a low total peripheral white blood cell count or lymphopenia at admission. An H5-specific reverse-transcription PCR assay (RT-PCR) was useful for rapid detection of virus directly in respiratory specimens. A commercially available enzyme immunoassay was more sensitive than direct immunofluorescence for rapid viral diagnosis. Direct immunofluorescence with an H5-specific monoclonal antibody pool was useful for rapid exclusion of H5-subtype infection.
Avian Influenza A H5N1 virus causes human influenza-like illness with a high rate of complications in adults admitted to hospital. Rapid H5-subtype-specific laboratory diagnosis can be made by RT-PCR applied directly to clinical specimens.
最近在香港报告了人类感染甲型禽流感病毒（H5N1亚型）的病例。我们描述了首批12例患者的临床表现以及快速病毒诊断的方法。
分析了12例经病毒培养确诊为甲型H5N1流感感染患者的病历。确定了临床表现和与严重疾病相关的危险因素，并比较了快速病毒诊断方法的结果。
患者年龄从1岁至60岁不等。临床表现为流感样疾病，7例患者有肺炎迹象。所有13岁以上的7例患者病情严重（4例死亡），而5岁及以下儿童症状较轻，但有1例因摄入阿司匹林并发瑞氏综合征死亡。胃肠道表现、肝酶升高、与横纹肌溶解无关的肾衰竭和全血细胞减少异常突出。与严重疾病相关的因素包括年龄较大、住院延迟、下呼吸道受累以及入院时外周血白细胞总数低或淋巴细胞减少。一种H5特异性逆转录聚合酶链反应检测法（RT-PCR）可用于直接在呼吸道标本中快速检测病毒。一种市售酶免疫测定法在快速病毒诊断方面比直接免疫荧光更敏感。用H5特异性单克隆抗体库进行直接免疫荧光有助于快速排除H5亚型感染。
甲型H5N1禽流感病毒可导致人类流感样疾病，住院成人并发症发生率高。可通过直接应用于临床标本的RT-PCR进行快速的H5亚型特异性实验室诊断。
